Choroidal neovascularization(CNV)is one of common causes of vision loss.The pathogenesis and development of CNV are a comprehensive process which is regulated by multiple factors and cytokines.Cyclooxygenase-2(COX-2)is an inducible isoform of cyclooxygenase and rate limiting enzyme in the prostaglandin biosynthesis pathway.COX-2 plays an important role in neovascularization by modulating vascular endothelial growth factor(VEGF),migration and apoptosis of endothelial cell.Recently,some experimental studies demonstrated that COX-2 involves in the information of CNV and the inhibitor of COX-2 can suppress CNV.These results provide a new prospect for the prevention and treatment of the CNV.Biological characteristics of COX-2 and its relationship with CNV are reviewed in this article.

Objective:To monitor the effects of asarone injections on the expression of IL-25, IL-27 and eosinophils cationic pro-tein ( ECP) in the serum of asthma patients. Methods:Totally 100 patients with bronchial asthma were randomly divided into the ob-servation group ( 55 cases ) and the control group ( 45 cases ) . The control group was treated with the conventional symptomatic treat-ment ( oxygen inhalation, spasmolysis and anti-asthma, and anti-infection, etc) . The observation group was given asarone injections 24 mg in 250 ml 0. 9% sodium chloride infusions, once a day for 14 days on the basis of the conventional therapy. The changes in symp-toms, and pulmonary function in the patients were observed with simultaneous detection of IL-25, ECP and IL-27 levels. Results:To-tal effective rate of the observation group was 92. 7%,which was higher than that of the control group (P<0. 05). Asarone injections could decrease IL-25, ECP and IL-27 levels in the observation group compared with those in the control group with statistically signifi-cant difference (P<0. 05 or 0. 01). Conclusion:Asarone injections can decrease the levels of IL-25, IL-27and ECP in the serum of asthma patients and inhibit the formation of inflammatory cells to alleviate the symptoms of airway inflammation.

Objective To explore the correlation between caring behavior and critical thinking of nursing students in clinical practice. Methods Totally 203 nursing students in clinical practice were investigated with Critical Thinking Disposition Inventory- Chinese Version (CTDI- CV) and Caring Behavior Scale (CBS). Results The structural model obtained a good fit. Critical thinking and caring behavior were positively correlated with each other(β=0.46,P<0.01). Conclusions Nursing students′caring behavior could improve their critical thinking. With the cultivation of critical thinking of nursing students, nursing educators should pay attention to improving their caring behavior.

Background It is estimated that discoidin domain receptor 2 (DDR2) and matrix metalloproteinase-13 (MMP-13) play an important role in the development of tumor angiogenesis.However,their effects on choroidal neovascularizaiton (CNV) have not been clarified yet.Objective This study was to observe the expression pattern of DDR2 and MMP-13 in CNV and to further investigate the regulation role of MEK/ERK and PI3K/Akt pathways to the expression of DDR2 and MMP-13 in CNV.Methods CNV models were established in 78 Brown Norway (BN) rats by retinal photocoagulation with 532 nm laser.Then the animals were randomly divided into the normal control group (n =7),the model control group (n =39),PD98059 (MEK1 inhibitor) group (n =16) and LY294002 (PI3K inhibitor) group (n =16),and 5 mmol/L PD98059 or 5 mmol/L LY294002 3 μl was intravitreally injected 1 day and 7 days after photocoagulation in the PD98059 group or LY294002 group.The expression of DDR2 and MMP-13 mRNA and proteins in the CNV area were detected by using reverse transcription PCR (RT-PCR),and the expression levels of p-ERK/ERK and p-Akt/Akt protein were detected by Western blot assay.CNV thickness was measured by pathological examination 14 days after photocoagulation,and the changes of CNV thickness,the expression levels of DDR2 and MMP-13 in CNV were compared among the model control group,PD98059 group and LY294002 group.Results Three days after photocoagulation,the cells within the lasered lesions proliferated,then CNV formed 7 days after photocoagulation and became stable 14 days after photocoagulation.Immunohistochemistry staining indicated that DDR2 was weakly expressed in the cells of ganglion cell layer,inner nuclear layer and vascular endothelial cells;while MMP-13 was strongly expressed in the cells of the inner limiting membrane layer,photoreceptor layer and sclera layer.Both DDR2 and MMP-13 were strongly expressed in CNV area.Double immunofluorescence staining revealed that MMP-13 and DDR2 co-expression in CNV area.RT-PCR revealed that the relative DDR2 mRNA levels at 1 day,3 days,7 days and 14 days after photocoagulation were 55.22±4.03,47.74±2.23,14.82±4.56 and 5.59±2.47 respectively,while the relative MMP-13 mRNA levels were 25.54±3.83,43.51±4.36,10.90±4.00 and 5.23±3.23 respectively.Compared with the normal control group,the expression of DDR2 and MMP-13 were significantly increased (all at P＜0.05).Immunofluorescence staining showed that the relative fluorescence unit (RFU) values at 1 day,3 days,7 days and 14 days after photocoagulation were 2.73±0.53,5.21±0.31 and 3.22±0.33 for DDR2 and 1.66±0.17,3.57±0.44,2.67±0.21 for MMP-13,respectively.The RFU values in the PD98059 group and LY294002 group 14 days after photocoagulation were 1.14±0.19,1.03±0.14 for DDR2 and 1.37±0.25,1.24±0.20 for MMP-13,respectively.Compared with the model control group,the differences were statistically significant (both at P＜0.05).Western blot results showed that,compared to the normal control group,the expression levels of p-ERK and p-Akt pretein increased at day 7 after photocoagulation (both at P＜0.05),and returned back to the baseline at day 14 after photocoagulation (both at P＞0.05).Both PD98059 and LY294002 treatment were able to attenuate the thickness of CNV to 57.21％ and 50.34％ at day 14 after photocoagulation and further decrease the expression levels of DDR2 and MMP-13 in CNV (all at P＜0.05).Conclusions The expressions of DDR2 and MMP-13 up-regulate in laser-induced CNV.MEK/ERK and PI3K/Akt pathways suppress the development of CNV by regulating the expression of DDR2 and MMP-13.

Objective To investigate the treatment of inverted nipple by continual extension with S tractors made of Kirschner wires on the base of preliminary clinical obervation.Methods Under local anesthesia,with the inverted nipples being dragged out by a presutured thread or a pair of towel clips,a Kirschner wire of 10 cm long and 0.5-1.0 mm in diameter was transversly penetrated through the base of inverted nipple.Then the Kirschner wire was bended at both points of 1.5 cm distantly from the nipple center in clockwise cemicircularly.Two cemicircular Kirschner wires were folded downward hingelikely and the center axis was supported by two cemicircles.This folded S tractor pushed and supported the inverted nipple forwardly and constantly.The hinge angle was adjusted during the treatment according to the traction requirment.It was nessessary for wearing these S tractors for at least 6 months before the Kirschner wires were being taken out.During referrals,the hinge angle was revised for mentaining the extension efforts.Results We treated 32 cases of inverted nipple,total 58 moderate and severe lesions,with this method effectively.No infection was observed during the treatment.The nipple form was naturally and stably outstanding after Kirschner wires taken out.No relapses were observed during a mean 6 monthe following up.Conclusions This procedure is simple and convenient without the need of complicated surgical procedures or perplexed equipments.The nipple shaps are observed natural and stable after Kirschner wire is removed.No recurrences are observed.There are no damages to breastfeeding function.The obvious drawback of this method is its reqairing of long continuously wearing and its inconvenience.

Objective To compare the effect of video-assisted minithoracotomy(VAMT)and video-assisted thoracoscopic surgery(VATS)for spontaneous pneumothorax.Methods 98 patiens with spontaneous pneumothorax allocated to VAMT or VATS were selected.The operation time,blood loss during operation,score of postoperative pain,time of postoperative drainage,postoperative hospital stay,surgery cost,rate of complication and recurrence were compared between the two groups.Results All patients were cured.The operation time,postoperative hospital stay and surgery cost were significantly different between VAMT and VATS groups(all P ＜0.05).The parameters of two groups were similar in score of postoperative pain,time of post-operative drainage,blood loss during operation,rate of complication and recurrence(all P ＞ 0.05).Conclusion VAMT was as effective as VATS,but the operation time,postoperative hospital stay and surgery cost was significantly better than VATS.

OBJECTIVE To evaluate the effectiveness of ~(125)I seeds brachytherapy in advanced head and neck malignant tumor.METHODS Twelve patients with post-radiotherapy recurred laryngeal cancer with bilateral cervical lymph node metastasis, tongue cancer with bilateral cervical lymph node metastasis or recurred maxillary sinus cancer and so on were operated radically,and ~(125)I seeds were implanted in wound area during operation.RESULTS With a follow-up of 24 to 32 months,no tumor recurred in 11 patients,and only one patient with tongue cancer recurred at 6 month after operation.No local infection, acute radioactive lesion,vessel broken or seeds migration happened.CONCLUSION The ~(125)I brachytherapy can be used as one of the comprehensive treatment method in advanced head and neck malignant tumors,especially in the recurred tumors after operation or radiotherapy or in the cancer which can not be radically removed.It's also an effective method to improve local control in the subset of patients with doubtful positive margins.

Objective We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal di-alysis ( PD) . Methods In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 ( control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place.Per-itonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. Results In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy.After implementation of the CQI initiative, the peritonitis rate de-clined to 1 episode in 77.3 patient-months from 1 episode in 22.6 patient-months.In the CQI group, the complicance of blood pressure was more significantly improved than the control group ( 67.8% vs 47.4%,P<0.05).During the 3 years of follow-up,cardiothoracic ratio and IVST were significantly increased in the control group [0.55 ± 0.08 vs 0.51 ±0.05,P<0.05,11.07 ±1.66 mm vs 10.25 ±1.38 mm, P<0.05〗.The difference of LVID between the two groups was signifi-cant at the 2nd and 3rd year of follow-up(P<0.05).Patient survival at 1, 2, and 3 years was significantly higher in the CQI group (97.3%, 96.3%, and 96.3%respectively) than in the control group (92.6%, 82.4%, and 67.3%respectively, P<0.001).Imple-mentation of the CQI initiative also appeared to significantly improve technique survival rates:95.6%, 92.6%, and 92.6%in the CQI group compared with 89.6%, 79.2%, and 76.8%in the control group (P<0.001) after 1, 2, and 3 years respectively. Conclusion Integration of a CQI process into a PD program can significantly improve the quality of therapy and its outcomes.

Objective Our previous study showed that cycloxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) are expressed in choroidal neovascularization (CNV) and the expression of COX-2 is prior to VEGF, indicating that COX-2 is probably one of upstream regulatory factors of VEGF. The aim of this study was to observe inhibition and mechanism of intravitreous injection of celecoxib, a selective COX-2 inhibitor, on experimental choroidal neovascularization in a laser-induced rat model. Methods Retinal photocoagulation was performed in 36 right eyes of 36 male Brown Norway rats to establish CNV models with the laser parameter as follows:wavelength 532 nm, power 80 mW, spot diameter 100 p, m and time shutter 100 ms. Eight or ten spots were irradiated in the position of 1.5 - 2. 0 PD to optic disc. Celecoxib or normal saline solution was intravitreously injected via scleral incision in 18 right eyes of 18 rats, respectively. The thickness and area of CNV were qualified by HE staining(n =3) and by choroidal flatmount (n =3) at day 14 after photocoagulation under the light microscope. The expressions of VEGF and COX-2 in RPE-choroid-sclera complex were examined by Western blot(n =6) and RT-PCR(n =6) at day 7 after photocoagulation. The experimental procedure followed the Standard of Association for Research in Vision and Ophthalmology. The license for animal administration was obtained. Results After intravitreous injection with celecoxib, the thickness and area of CNV were significantly smaller in celecoxib group than normal saline group on 14 days (69. 75 μm ± 7. 50 μm vs 45. 84 μm ± 5. 59 μm in thickness and 87 854 pixel~2 ± 6 735 pixel~2 vs 61 101 pixel~2 ± 6 314 pixel~2 in area, P =0.00). The expressions of VEGF protein and mRNA were obviously lower in celecoxib group compared with normal saline group(t = 3. 755, P = 0.02; t =3. 155, P =0. 03) . No significant difference was found in expression of COX-2 mRNA between the two groups (t = 0. 581, P = 0. 59). Conclusion Intravitreous injection of celecoxib can effectively inhibit CNV by downregulating VEGF level, which is a new approach for the treatment of CNV.

OBJECTIVE: To determine the risk factors for mechanical ventilation offline in patients with severe pneumonia. METHODS: Th e data of 59 patients, who were admitted to the First Hospital of Changsha because of severe pneumonia and required mechanical ventilation between June 2011 and December 2013, were reviewed retrospectively. The patients were divided into two groups: a successful weaned group (n=31) and a failure group (n=28). Th e patients' background, laboratory and bacteriological examinations at the beginning of mechanical ventilation were recorded. All the indexes were analyzed by univariate analysis and logistic regression analysis. RESULTS: Univariate analysis showed that there was no significant difference in gender and age in the 2 groups (P>0.05). Smoker, APECHE II score, D-dimer and brain natriuretic peptide (BNP) concentration in the success weaned group were lower than those in the failure group. The difference between the 2 groups was significant (P<0.05). The serum albumin level in patients of the success weaned group at the time of entering respiratory intensive care unit was higher than that in the failure group, with significant difference (P<0.05). The logistic regression analysis showed that the high concentration of D-dimer, lung diseases based on thoracic CT and low serum albumin were independent risk factors for mechanical ventilation offline in severe pneumonia patients. CONCLUSION The severe pneumonia patients with low albumin, high concentration of D-dimer and lung diseases should be comprehensive evaluated and receive treatment, which is beneficial to the mechanical ventilation offline.
Fibrin Fibrinogen Degradation Products ; analysis ; Humans ; Intensive Care Units ; Lung Diseases ; Pneumonia ; therapy ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Serum Albumin ; analysis ; Treatment Failure